Core Welfare Indicator Questionnaire Survey 2007

The survey instruments included the modified generic scannable CWIQ questionnaire; the interviewer's manual and supervisor's manual. CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 IMPORTANT Create a reference number by combining the household and questionnaire numbers. Write this number NOW on the top of all pages. Page 1 of 14 Q.1 INTERVIEWER'S NAME A.1 CLUSTER A.2 HOUSEHOLD A.3 SEQ. A.4 INTERVIEWER A.5 DATE A.6 TIME A.7 RESPONDENT Q.2 NAME OF HEAD OF HOUSEHOLD Q.3 PROVINCE/REGION Q.4 DISTRICT Statistics Sierra Leone A.J. Momoh Street Freetown, Sierra Leone Comments A - INTERVIEW INFORMATION C W I Q Core Welfare Indicators Questionnaire I Q.5 LOCAL COUNCIL Q.6 CHIEFDOM/WARD Quest. N o. Hour Min. AM PM Member N o. A.8 RESULT Complete with selected household Complete with replacement - refusal Complete with replacement - not found Incomplete 1 2 3 4 A.9 INTERVIEW END Hour Min. AM PM PRINTING AND SHADING INSTRUCTIONS For optimum accuracy, please print carefully and avoid contact with the edges of the box. The following will serve as an example: Tel: 022-223287 Q.7 SECTION Q.8 VILLAGE/LOCALITY Day Mon th Y ear Reference Number 8862244644 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 IF RESPONSE IS NO OR DON'T KNOW GO TO NEXT PERSON MEMBER NUMBER 1 2 3 4 5 6 7 8 9 10 Head B Page 2 of 14 - LIST OF HOUSEHOLD MEMBERS WRITE DOWN THE NAMES OF ALL PERSONS WHO NORMALLY LIVE AND EAT TOGETHER IN THIS HOUSEHOLD, STARTING WITH THE HEAD. B.1 Is [NAME] male or female? Male Female B.2 How long has [NAME] been away in the last 12 months? Never Less than 6 months 6 months or more B.3 What is [NAME]'s relationship to the head of household? Head Spouse Child Parent Other relative Not related B.4 How old was [NAME] at last birthday? (RECORD AGE IN COMPLETED YEARS.) B.9 Is [NAME]'s mother living in the household? Yes No What is [NAME]'s marital status? Never married Married(monogamous) Married(polygamous) Divorced Separated Widowed Is [NAME]'s father alive? Yes No Don't know B.7 Is [NAME]'s father living in the household? Yes No B.8 Is [NAME]'s mother alive? Yes No Don't know M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N IF RESPONSE IS NO OR DON'T KNOW GO TO B.8 M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N M F 1 2 3 1 2 3 4 5 6 1 2 3 4 5 6 Y N X Y N Y N X Y N B.5 IF PERSON IS UNDER AGE 10 GO TO B.6 B.6 IF PERSON IS AGED 18 OR ABOVE GO TO NEXT PERSON Reference Number 7226244647 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 GO TO NEXT PERSON GO TO NEXT PERSON MEMBER NUMBER 1 2 3 4 5 6 7 8 9 10 Page 3 of 14 C - EDUCATION Can [NAME] read and write in any language? Yes No C.2 Has [NAME] ever attended school? Yes No Why has [NAME] not started school? (YOU MUST MARK AT LEAST ONE ANSWER) a Too young b Too far away c Too expensive d Is working (home or job) e Useless/uninteresting f Illness g Other C.3 What is the highest grade [NAME] completed? C.4 Did [NAME] attend school last year? Yes No C.5 Is [NAME] currently in school? Yes No C.6 What is the current grade [NAME] is attending? C.7 Who runs the school [NAME] is attending? Government Religious organization Private Community Other C.8 Did [NAME] have any problems with school? (YOU MUST MARK AT LEAST ONE ANSWER) a No problem (satisfied) b Lack of books/supplies c Poor teaching d Not enough teachers e Teachers often absent f Lack of space g Facilities in bad condition h High fees i Other problem C.9 Why is [NAME] not currently in school? (YOU MUST MARK AT LEAST ONE ANSWER) a Completed school b Too far away c Too expensive d Is working (home or job) e Illness f Drug related problem g Pregnancy h Got married i Useless/uninteresting j Failed exam k Awaiting admission l Dismissed m Other C3 - Highest grade completed 00 None 01 Pre-school 11 P1 21 JSS1 31 University 12 P2 22 JSS2 41 Vocational 13 P3 23 JSS3 42 Teacher training 14 P4 24 SSS1 43 Technical 15 P5 25 SSS2 16 P6 26 SSS3 C6 - Current grade attending 01 Pre-school 11 P1 21 JSS1 31 University 12 P2 22 JSS2 41 Vocational 13 P3 23 JSS3 42 Teacher training 14 P4 24 SSS1 43 Technical 15 P5 25 SSS2 16 P6 26 SSS3 Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y N Y N 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y IF C5 RESPONSE IS NO GO TO C.9 IF C2 IS NO AND [NAME]IS BELOW 19 YEARS GO TO C.10; ELSE GO TO NEXT PERSON C.10 ASK C10 IF PERSON IS BELOW 19 YEARS C.1 ASK C.1 IF PERSON IS AGE 15 OR ABOVE OTHERWISE GO TO C.2 Reference Number 2017244640 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 MEMBER NUMBER 1 2 3 4 5 6 7 8 9 10 Page 4 of 14 D - HEALTH D.1 Is [NAME] physically or mentally handicapped or disabled? Include person only if handicap prevents him or her from maintaining a significant activity or schooling. What sort of sickness/injury did [NAME] suffer? (YOU MUST MARK AT LEAST ONE ANSWER) D.5 What kind of health provider did [NAME] see? D.6 How did [NAME] pay for the consultation? a No need b Too expensive c Too far d Lack of confidence e Other D.8 Why did [NAME] not use medical care in the last 4 weeks? (YOU MUST MARK AT LEAST ONE ANSWER) D.2 Was [NAME] sick or injured in the last 4 weeks? D.4 Did [NAME] consult a health provider or traditional healer for any reason in the last 4 weeks? D.7 Did [NAME] have any problems at the time of the visit? (YOU MUST MARK AT LEAST ONE ANSWER) GO TO NEXT PERSON Yes No Yes No a Fever/malaria b Diarrhea/abdominal pains c Pain in back, limbs or joints d Cough/breathing difficulties e Skin problems f Ear, nose or throat g Eye h Dental i Accident j Other Government hospital Community health centre Community health post Maternal/child health post Village health worker Mobile outreach clinic Private health facility Pharmacist/chemist Private physician/dentist Traditional healer Drug peddler Free Household paid Employer Insurance Relative a No problem (satisfied) b Facilities were not clean c Long waiting time d No trained professionals e Too expensive f No drugs available g Treatment unsuccessful h Other Yes No IF RESPONSE IS NO GO TO D.4 IF RESPONSE IS NO GO TO D.8 GO TO NEXT PERSON Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y D.3 Y N Y N Y Y Y Y Y Y Y Y Y Y Y N A B C D E F G H I J K 1 2 3 4 5 Y Y Y Y Y Y Y Y Y Y Y Y Y Reference Number 4570244646 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 IF RESPONSE IS NO GO TO NEXT PERSON GO TO NEXT PERSON MEMBER NUMBER 1 2 3 4 5 6 7 8 9 10 Page 5 of 14 E - EMPLOYMENT Did [NAME] do any type of work in the last 7 days, even if only for one hour? Yes No E.2 Was [NAME] absent from work in the last 7 days? Yes No E.3 Has [NAME] been looking for work and ready for work in the last 4 weeks? Yes No E.4 What was the main reason [NAME] was not working in the last 7 days? E.9 Did [NAME] seek to increase his or her earnings in the last 7 days? Yes No E.10 How did [NAME] seek to increase earnings in the last 7 days? More hours current activity More hours additional activity Change activity Other E.11 Is [NAME] ready to take on additional work in the next 4 weeks? Yes No No work available Seasonal inactivity Student Household/family duties Too old Too young Infirmity Retired Other E.5 How many jobs did [NAME] have in the last 7 days? E.6 What is the main activity at the place of [NAME's] main job? 01 Crop farming 06 Manufacturing/processing 11 Banking/financial services 02 Livestock/poultry 07 Electricity/gas/water supply 12 Community services 03 Forestry/logging 08 Construction 13 Other 04 Fishing 09 Wholesale/retail trades/hotels & restaurants 05 Mining/quarrying 10 Transport, storage, communications E.7 For whom did [NAME] work in the main job? Government/public sector Private sector 1 Central government/Civil service 4 Private enterprise > 5 employees 2 Local government/public sector 5 Private enterprise<=5 employees 3 NGO/International organization/ 6 Family farm/business diplomatic mission/Parastatal/ 7 Other private sector E.8 What is [NAME'S] employment status in the main job? Regular wage or salaried employee Casual paid employee Self employed with employees Self employed no employees Unpaid family worker Apprentice Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N Y N Y N 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 Y N 1 2 3 4 Y N IF RESPONSE IS YES GO TO E.5 IF RESPONSE IS YES GO TO E.5 E.1 IF PERSON IS UNDER AGE 5 GO TO NEXT PERSON Reference Number 2783244640 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 Page 6 of 14 F - HOUSEHOLD ASSETS F.7 How does the amount of other land used compare with one year ago? F.14 How far from here is it to reach the nearest ...? Hours:Minutes MILES Hours:Minutes MILES F.6 How many acres of land does the household use that it does not own? (with one decimal, e.g. 24.7) F.8 Does the household own any of the following? Include items only if they are in working condition IF RESPONSE IS NO GO TO F.7 F.1 Does the household or a household member own the dwelling? 1 2 3 4 Owns the dwelling Rents the dwelling Uses without paying rent Nomadic or temporary dwelling F.2 What type of documents do you have to prove your occupancy? 1 2 3 4 5 6 Certificate of occupancy Leasehold Freehold Tenancy agreement Receipt for payment None F.3 How many acres of cultivable land are owned by the household? (with one decimal, e.g. 24.7) Less now Same now More now Don't know 1 2 3 4 F.4 How does the amount of land owned compare with one year ago? No Rented Sharecropped Private land provided free Communal land 1 2 3 4 5 F.5 Does the household use land it does not own? 1 2 3 4 Less now Same now More now Don't know a) Electric Iron Y N b) Charcoal iron Y N c) Refrigerator Y N d) Television Y N e) VCR/DVD Y N f) Radio Y N g) Land line phone Y N h) Mobile/cell phone Y N i) Computer Y N j) Generator Y N k) Fan Y N l) Mattress or bed Y N m) Watch or clock Y N n) Sewing machine Y N o) Modern stove Y N p) Bicycle Y N q Motorcycle Y N r) Car or truck Y N s) Push cart/Omolankay Y N a) Food needs 1 2 3 4 5 b) School fees 0 1 2 3 4 5 c) House rent 0 1 2 3 4 5 d) Utility bills 0 1 2 3 4 5 e) Health care 0 1 2 3 4 5 S o N m o S e A t N e t O l e l i f w A v d m t a p e o e e y p r m s n s F.9 How often in the last year did you have problems satisfying the following needs of the household? Much worse now A little worse now Same A little better now Much better now Don't know 1 2 3 4 5 6 F.10 How do you compare the overall economic situation of the HOUSEHOLD with one year ago? Much worse now A little worse now Same A little better now Much better now Don't know 1 2 3 4 5 6 F.11 How do you compare the overall economic situation of the COMMUNITY with one year ago? Much worse now A little worse now Same A little better now Much better now Don't know 1 2 3 4 5 6 F.12 How do you compare the level of crime and safety in your NEIGHBORHOOD with one year ago? F.13 Who contributes most to household income? (record member number from section B). Supply of drinking water Food market Public transportation Primary school Secondary school Health clinic/hospital All season road Any road (vehicle) Reference Number 0785244640 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 Page 7 of 14 G - HOUSEHOLD AMENITIES G.5 How many rooms does this household occupy? G.1 What is the material of the floors of the house? G.2 What is the material of the roof of the house? Thatch/grass/straw Wood Corrugated iron sheets/zinc/tin Tarpaulin/plastic sheet Cement/concrete Roofing tiles Asbestos Other G.9 What is the main source used for lighting? G.6 What is the main source of drinking water? Piped into dwelling/yard/plot Public tap/standpipe Bore hole/tube well/mechanical well Protected well/spring Unprotected well/spring Surface water (river, lake, pond) Collected rain water Water vendor/bowser/bottled Other G.7 What kind of toilet facility does your household use? G.3 What is the material of the walls of the house? Mud and wattle Mud bricks Corrugated iron sheets/zinc/tin Stone/burnt bricks/clay bricks Sandcrete/cement blocks Timber/wood Poles/reeds Tarpaulin/plastic sheet Other __ H - POVERTY PREDICTORS G.12 May I see a sample of the salt used to cook the main meal eaten by members of the household last night? H.6 Do you consider your household to be very poor, somewhat poor, or not poor? H.7 Was the head of household (respondent) born in this village or town? EXCLUDE BATHROOMS, TOILETS, KITCHEN, PANTRY, AND STOREROOMS G.10 What kind of refuse collection does your household use? H.1 To which ethnic group does the head of household belong? Krio Mende Temne Limba Loko Kissi Sherbro Kono Mandingo Other G.11 What measures does your household take to prevent malaria? (YOU MUST MARK AT LEAST ONE ANSWER) Earth/mud Wood planks Stone Tiles Cement/concrete Polished wood Other 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 G.4 What is the type of the housing unit? Single room Flat Duplex Whole building Other _ 1 2 3 4 5 1 2 3 4 5 6 7 8 9 None/bush/field/water Flush to sewer Flush to septic tank Ventilated covered pit latrine (VIP) Covered pit latrine (with slab) Uncovered pit latrine (without slab) Pan/bucket Hanging toilet/latrine (over water) Other ___ 1 2 3 4 5 6 7 8 9 G.8 What is the main fuel used for cooking? Firewood Charcoal Kerosene/oil Gas Electricity Crop residue/sawdust Animal waste Other 1 2 3 4 5 6 7 8 Kerosene Gas Mains electricity Generator Battery Candles Firewood None Other 1 2 3 4 5 6 7 8 9 Collected government Collected private Government bin Disposal within compound None/Unauthorized heap Other 1 2 3 4 5 6 a) None b) Bed net c) Insecticide d) Anti-malaria drug e) Fumigation f) Insecticide treated net g) Maintain good drainage h) Maintain good sanitation i) Herbs j) Burn leaf (tobacco, etc.) k) Window/door net l) Other Y Y Y Y Y Y Y Y Y Y Y Y Not iodized 0 ppm < 15 ppm 15 ppm or more No salt Salt not tested 1 2 3 4 5 0 1 2 3 4 5 6 7 8 9 H.2 Has the household purchased any matches in the last 3 months? Yes No Y N H.3 Has the household purchased any aspirin in the last 3 months? Yes No Y N Yes No Y N H.4 Has the household purchased any rice in the last 3 months? H.5 Has the household purchased any bread in the last 3 months? Yes No Y N Very poor Somewhat poor Not poor 1 2 3 Yes No Y N Reference Number 8764244645 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 I.1 For each child under 5 enter the child and mother's number from the list of household members. Enter 00 if the child's mother is deceased or is not a member of the household. I.2 Enter the child's date of birth. I.3 Has the child ever been breastfed? I.4 Is the child still being breastfed? I.5 Since this time yesterday, did the child eat solid, semi-solid or soft food or drink water, juice or other liquid during the day or night? I.6 Record each child's weight (kg with one decimal, e.g. 4.6 kg) and height (cm with one decimal, e.g. 51.3 cm). I.7 Did the child participate in the following? I.8 Has the child been vaccinated against: I.9 Has the child received a vitamin A dose during the last 6 months? (SHOW VITAMIN A CAPSULE) I.10 Did the child sleep under a mosquito net last night? I.11 Has the bed net been treated with insecticide to repel insects? I.12 Why didn't the child sleep under a mosquito net last night? I.13 Has the child had diarrhea in the last 2 weeks? Page 8 of 14 I - CHILDREN UNDER 5 IF NO OR DON'T KNOW GO TO NEXT CHILD I.14 During the episode of diarrhea did the child drink any of the following? YOU MAY MARK MULTIPLE ANSWERS IF NO OR DON'T KNOW GO TO I.12 IF NO OR DON'T KNOW GO TO I.5 GO TO I.13 a) ORS packet solution b) Home made sugar-salt solution c) More fluid than usual a) ORS packet solution b) Home made sugar-salt solution c) More fluid than usual a) ORS packet solution b) Home made sugar-salt solution c) More fluid than usual Child Mother Day Month Year Yes No Don't know Y N X Y N X Yes No Don't know Y N X Yes No Don't know Weight Height Nutrition program Y N Weigh-ins Y N No Card Resp. a) Measles 0 1 2 b) BCG 0 1 2 c) 5 in 1/DPT1 0 1 2 d) 5 in 1/DPT2 0 1 2 e) 5 in 1/DPT3 0 1 2 f) Polio0 0 1 2 g) Polio1 0 1 2 h) Polio2 0 1 2 i) Polio3 0 1 2 j) Yellow fever 0 1 2 Yes No Don't know Y N X Yes No Don't know Y N X Yes No Don't know Y N X No net No mosquitos Too hot/net is a prison Can't afford net Other 0 1 2 3 4 Yes No Don't know Y N X Y Y Y Child Mother Day Month Year Yes No Don't know Y N X Y N X Yes No Don't know Y N X Yes No Don't know Weight Height Nutrition program Y N Weigh-ins Y N No Card Resp. a) Measles 0 1 2 b) BCG 0 1 2 c) 5 in 1/DPT1 0 1 2 d) 5 in 1/DPT2 0 1 2 e) 5 in 1/DPT3 0 1 2 f) Polio0 0 1 2 g) Polio1 0 1 2 h) Polio2 0 1 2 i) Polio3 0 1 2 j) Yellow fever 0 1 2 Yes No Don't know Y N X Yes No Don't know Y N X Yes No Don't know Y N X No net No mosquitos Too hot/net is a prison Can't afford net Other 0 1 2 3 4 Yes No Don't know Y N X Y Y Y Child Mother Day Month Year Yes No Don't know Y N X Y N X Yes No Don't know Y N X Yes No Don't know Weight Height Nutrition program Y N Weigh-ins Y N No Card Resp. a Measles 0 1 2 b BCG 0 1 2 c 5 in 1/DPT1 0 1 2 d 5 in 1/DPT2 0 1 2 e 5 in 1/DPT3 0 1 2 f Polio0 0 1 2 g Polio1 0 1 2 h Polio2 0 1 2 i Polio3 0 1 2 j Yellow fever 0 1 2 Yes No Don't know Y N X Yes No Don't know Y N X Yes No Don't know Y N X No net No mosquitos Too hot/net is a prison Can't afford net Other 0 1 2 3 4 Yes No Don't know Y N X Y Y Y Child Mother Day Month Year Yes No Don't know Y N X Y N X Yes No Don't know Y N X Yes No Don't know Weight Height Nutrition program Y N Weigh-ins Y N No Card Resp. a Measles 0 1 2 b BCG 0 1 2 c 5 in 1/DPT1 0 1 2 d 5 in 1/DPT2 0 1 2 e 5 in 1/DPT3 0 1 2 f Polio0 0 1 2 g Polio1 0 1 2 h Polio2 0 1 2 i Polio3 0 1 2 j Yellow fever 0 1 2 Yes No Don't know Y N X Yes No Don't know Y N X Yes No Don't know Y N X No net No mosquitos Too hot/net is a prison Can't afford net Other 0 1 2 3 4 Yes No Don't know Y N X a) ORS packet solution b) Home made sugar-salt solution c) More fluid than usual Y Y Y Reference Number 4473244648 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 Page 9 of 14 J - MCH J.1 For each woman in the household age 15 to 49 enter the women's number from the list of household members. J.2 Did [NAME] have a live birth in the last 24 months? IF RESPONSE IS NO GO TO NEXT WOMAN J.4 Did [NAME] visit a health facility for antenatal care during the pregnancy? J.5 How many times did [NAME] visit a health facility during the preganancy? J.6 Did [NAME] receive an injection in the arm to prevent tetanus during the pregnancy? J.3 Was the birth registered? J.7 How many times did [NAME] get this injection during the preganancy? J.8 Where was the child delivered? J.9 Who assisted [NAME] with the delivery of the child? (YOU MUST MARK AT LEAST ONE ANSWER) GO TO NEXT WOMAN IF RESPONSE IS NO GO TO J.8 IF RESPONSE IS NO OR DON'T KNOW GO TO J.8 8 = Don't know 88 = Don't know 88 = Don't know 88 = Don't know 88 = Don't know a) Doctor b) Nurse/midwife c) Auxiliary midwife d) Traditional birth attendant e) Relative/friend g Other a) Doctor b) Nurse/midwife c) Auxiliary midwife d) Traditional birth attendant e) Relative/friend f) Other a) Doctor b) Nurse/midwife c) Auxiliary midwife d) Traditional birth attendant e) Relative/friend g Other a) Doctor b) Nurse/midwife c) Auxiliary midwife d) Traditional birth attendant e) Relative/friend g Other Y N Yes No Yes No Don't know Y N X Yes No Y N Yes No Don't know Y N X Government hospital/maternity Government health clinic/center Private facility At home Other 1 2 3 4 5 Y Y Y Y Y Y Y N Yes No Yes No Don't know Y N X Yes No Y N Yes No Don't know Y N X 8 = Don't know Government hospital/maternity Government health clinic/center Private facility At home Other 1 2 3 4 5 Y Y Y Y Y Y Y N Yes No Yes No Don't know Y N X Yes No Y N Yes No Don't know Y N X 8 = Don't know Government hospital/maternity Government health clinic/center Private facility At home Other 1 2 3 4 5 Y Y Y Y Y Y Y N Yes No Yes No Don't know Y N X Yes No Y N Yes No Don't know Y N X 8 = Don't know Government hospital/maternity Government health clinic/center Private facility At home Other 1 2 3 4 5 Y Y Y Y Y Y Reference Number 2454244645 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 K.1 Did your household harvest any tree or plant crops in the 2006 agricultural season? IF NO GO TO K.24 ON PAGE 12 K.2 What was the total area in acres cultivated by your household in the 2006 agricultural season? Crop Upland rice Lowland rice Cassava Sweet potato Yam/ Cocoyam Ground nuts Palm oil K.6 Quantity harvested in the 2006 agricultural season: K.7 Quantity harvested compared to the previous agricultural seasons: Less now Same now More now Don't know K.8 Portion of harvest used for: Repayment Sale Food Seed K.10 Was any produce processed for sale? Yes No Page 10 of 14 K - AGRICULTURE K.3 In the 2006 agricultural season did you or anyone from your household participate in a farming work group? K.4 In the 2006 agricultural season did you or anyone from your household pay people (in cash or in kind) to work on your farm? Yes No K.5 Did your household harvest [CROP] in the 2006 agricultural season? Bushel Unit Bushel Bags Bags Bags Bags Batta IF NO HARVEST NEXT CROP K.11 Income from sales compared to the previous agricultural season: Less now Same now More now Don't know IF NO SALE GO TO K.11 K.9 Immediate point of sale: By self in market To private trader in market Buyer comes to house Taken to buyer in town Sold through business organiztion/Chief Other IF NO GO TO K.7 Yes No Y N Yes No Y N Y N Y N Yes No 1 2 3 4 1 2 3 4 5 6 Y N 1 2 3 4 Yes No Y N 1 2 3 4 1 2 3 4 5 6 Y N 1 2 3 4 Yes No Y N 1 2 3 4 1 2 3 4 5 6 Y N 1 2 3 4 Yes No Y N 1 2 3 4 1 2 3 4 5 6 Y N 1 2 3 4 Yes No Y N 1 2 3 4 1 2 3 4 5 6 Y N 1 2 3 4 Yes No Y N 1 2 3 4 1 2 3 4 5 6 Y N 1 2 3 4 Yes No Y N 1 2 3 4 1 2 3 4 5 6 Y N 1 2 3 4 Reference Number 8500244643 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 Maize Cocoa Coffee Cashews Ginger Citrus Vege- Crop tables Page 11 of 14 K - AGRICULTURE K.12b Did your household sell any of [CROP] harvested in the 2006 agricultural season? Yes No IF NO SALE GO TO K.15 K.13 Immediate point of sale: By self in market To private trader in market Buyer comes to house Taken to buyer in town Sold through business organiztion/Chief Other K.14 Was any produce processed for sale? Yes No K.15 Income from sales compared to previous agricultural season: Less now Same now More now Don't know K.16 Did you or any member of your household have to travel to sell any produce (SEE K.9 AND K.13)? Mode of transport: 1=Poda Poda 2=Truck 3=Head load 4=Private vehicle 5=Boat 6=Other Point of sale Distance (miles) Mode of transport Total cost of journey K.17 How does your household total income from sales of agricultural produce in the 2006 agricultural season compare to the previous season? K.19 What sources provided information? (YOU MUST MARK AT LEAST ONE ANSWER) K.20 Was any produce left in the field without harvesting? IF NO OR DON'T KNOW GO TO K.22 K.21 Why was the produce not harvested? K.22 Was any produce lost after harvest? IF NO OR DON'T KNOW GO TO K.24 IF NO HARVEST GO TO NEXT CROP K.12a Did your household harvest any [CROP] in the 2006 agricultural season? Yes No Y N Y N 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N 1 2 3 4 5 6 Y N 1 2 3 4 Y N Y N 1 2 3 4 5 6 Y N 1 2 3 4 a By self in market 1 2 3 4 5 6 b To private trader at market 1 2 3 4 5 6 c To buyer in town 1 2 3 4 5 6 Less now Same now More now Don't know 1 2 3 4 K.18 During the last 12 months has the household received any information about the market prices of agricultural produce? Yes No Don't know Y N X IF NO OR DON'T KNOW GO TO K.20 a Extension staff Y c Farmer field school Y e Radio Y g NGO Y i Other Y b Farmer association Y d Agricultural business unit Y f Newspaper/publications Y h Friends/relatives Y Yes No Don't know Y N X No labor to harvest Not needed/no market Can not get it to market Other 1 2 3 4 Yes No Don't know Y N X Reference Number 1916244647 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 Page 12 of 14 K - AGRICULTURE K.26 Agricultural services: Which of the following services/ installations exist in your area and are accessible to your household? Work across the form taking each service in turn and answering all questions as appropriate, before moving to the next service. K.23 What was the main reason for the post harvest crop losses? YOU MAY MARK MORE THAN ONE ANSWER IN COLUMN C IF NO CROP PRODUCTION AND NO LIVESTOCK OWNED END INTERVIEW AND GO TO A.8 (FRONT PAGE) Poor storage Pests Disease Rotting Other 1 2 3 4 5 B Number compared to number owned 12 months ago 1 Less now 2 Same now 3 More now 4 Don't know A Number owned now Ducks 1 2 3 4 Guinea fowl 1 2 3 4 Guinea pigs 1 2 3 4 Rabbits 1 2 3 4 Chickens 1 2 3 4 Work oxen 1 2 3 4 Pigs 1 2 3 4 Goats 1 2 3 4 Sheep 1 2 3 4 Cattle 1 2 3 4 A Number owned now 1 Less now 2 Same now 3 More now 4 Don't know B Number compared to number owned 12 months ago K.24 For each of the following animals: record (A) the number owned now and (B) the number now compared to the number owned 12 months ago. K.25 Did your household use any of the following agricultural inputs during the 2006 agricultural season? Agricultural input Use/source of agricultural inputs 0 Not used 1 MAFFS 4 Other donor/NGO 7 Exchange/barter 2 Local council 5 Purchased 8 Gift 3 ABU 6 Credit/loan 9 other A - Rice seeds not from own stock 0 1 2 3 4 5 6 7 8 9 B - Other seeds not from own stock 0 1 2 3 4 5 6 7 8 9 C - Chemical fertilizer 0 1 2 3 4 5 6 7 8 9 D - Insecticides or herbicides 0 1 2 3 4 5 6 7 8 9 E - Animal parent stock 0 1 2 3 4 5 6 7 8 9 F - Animal feed 0 1 2 3 4 5 6 7 8 9 G - Animal vaccines/drugs 0 1 2 3 4 5 6 7 8 9 SERVICE IF NO GO TO NEXT SERVICE A.Is the service accessible? Yes No IF YES GO TO NEXT SERVICE B.Do you use the service? Yes No C.If service not used, why not? 1 Cost 2 Poor service 3 Other 1 Drying floor Y N Y N 1 2 3 2 Store for rice Y N Y N 1 2 3 3 Rice hauler/mill Y N Y N 1 2 3 4 Cassava grinder Y N Y N 1 2 3 5 Palm oil mill Y N Y N 1 2 3 6 Tractor/power tiller hire Y N Y N 1 2 3 7 Animal holding area Y N Y N 1 2 3 8 Veterinary facilities Y N Y N 1 2 3 Reference Number 7309244649 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 K.32 How many times did the extension worker visit your household? K.30 In what way have you benefited from the activities of the farmer based organizations? (YOU MAY MARK MORE THAN ONE ANSWER) K.33 For whom does the extension worker work? 0 No 1 Yes, for a season 2 Yes, for long term K.28 From whom did you or members of your household obtain credit or loans for agricultural purposes (to grow crops, raise livestock, process agricultural produce) in the last 12 months? Page 13 of 14 K - AGRICULTURE IF NO OR DON'T KNOW GO TO K.29 K.27 In the last 12 months have you or any members of your household taken credit or loans for agricultural purposes (to grow crops, raise livestock, process agricultural produce)? K.29 In the last 12 months have you or any members of your household benefitted from the activities of the following farmer based organizations? (YOU MUST MARK AT LEAST ONE ANSWER) IF NO OR DON'T KNOW GO TO K.31 K.31 Did an extension worker visit your household in the last year? IF NO OR DON'T KNOW GO TO K.36 Yes No Don't know Y N X a Family/friends 0 1 2 b Community based association 0 1 2 c Trader or buyer 0 1 2 d Microfinance scheme 0 1 2 e Commercial bank 0 1 2 f Other private organization 0 1 2 g Other 0 1 2 a Farmer association for men Y b Farmer association for women Y c Farmer association for youth Y d Farmer field school Y e Agricultural business unit as individual Y f Agricultural business unit through association Y g No Y h Don't Know Y a Provision of employment Y b Provision of credit facilities Y c Provision of agricultural equipment Y d Provison of agricultural inputs (seeds, fertilizer) Y e Marketing advice - food crops Y f Marketing advice - cash crops Y g Access to irrigation Y h Record/book keeping Y i Provision of communal labor Y j Other Y Yes No Don't know Y N X Once or twice About 3-10 times About once a month About twice a month Three times a month Weekly Don't know 1 2 3 4 5 6 7 Government NGO Co-operative CBO Other (specify) _____ 1 2 3 4 5 Reference Number 1549244649 CWIQ2007(24464): Sierra Leone 2007 Main Survey 19-03-2007 K.34 Did the extension worker provide training and/or advice on any of the following? (YOU MUST MARK AT LEAST ONE ANSWER) IF NONE OF THE ABOVE GO TO K.36 K.35 Did your household use any of the extension worker's advice? K.36 What are the 3 main constraints to improving your household income from agricultural production? Lack of access to land 01 Insufficient labor availability 02 Lack of finance/credit 03 Insufficient seeds/poor quality of seeds 04 Lack of pesticides/fertilizer 05 Lack of tools/tcchnology e.g. power tiller/tractor 06 Crop damage in the field before harvest 07 Crop damage/losses in storage 08 Lack of access to markets 09 Lack of knowledge about markets 10 Page 14 of 14 K - AGRICULTURE a Use of seeds Y b Use of fertilizer Y c Use of tillers/tractors Y d Irrigation Y e Animal husbandry Y f Use of chemicals Y g Insecticides Y h Post harvest services Y i Provision of farming tools & equipment Y j Promotion of swampland cultivation Y k None of the above Y Yes No Y N Reference Number 9603244648